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Is excess medical vs medical payment different? If so, how? Are they both reimbursable?

Glendale, CA |

There was a settlement from small claims court for personal injuries against the fault driver. Fault driver's insurance paid the judgement to me and a portion of the bill was paid by my insurance through my excess medical. The medical provider that I was referred to during my treatment was not contracted with my health insurance. So my excess medical coverage kicked in and my insurance paid one bill up to my excess medical coverage. And I still owe $8000.00 on medical bills. I am in process of negotiating my other bills with the other providers. Do I still need to reimburse my insurance if there will be nothing left over my settlement?

Attorney Answers 4


  1. Ordinarily the excess medical payments are recoverable. However, under the"made whole" doctrine you are allowed to get a waiver.


  2. There are legal arguments to be made as to how having to reimburse your insurance is inequitable under the factual scenario that you have described. You are strongly urged to consult with a lawyer who can review the facts and make those arguments on your behalf.


  3. It depends upon whether your health insurance has a reimbursement provision. If so, then one is generally required to reimburse. Often times a carrier will negotiate a lien reduction. If you had more than $8,000.00 in medical bills for injuries sustained in the incident, you really should have been represented by a personal injury attorney.

    You probably should consult an attorney about your situtation.

    The information provided is for general informational purposes only and is not intended to be legal advice. I am only licensed in the State of California and I am not providing you with specific legal advice. The law changes frequently and varies from jurisdiction to jurisdiction. Being general in nature, the information provided may not apply to any specific factual and/or legal set of circumstances and/or the jurisdiction where you reside. No attorney-client relationship is formed nor should any such relationship be implied. The information provided is of a general nature is not intended to substitute for the advice of an attorney, especially an attorney licensed in your jurisdiction. Your question, although you may believe is simple, it is not simple. You require legal advice, please consult with a competent attorney licensed to practice in your jurisdiction.


  4. Excess medical is secondary to your health insurance. It will pay for what is not covered or paid by your health insurance. If you can show that your medical bills were higher than the settlement, your insurance carrier will generally waive their excess medical payment.

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